Download Your Caesarean Birth and Recovery

Government of Western Australia
Department of Health
Women and Newborn Health Service
Your Caesarean
Birth and Recovery
WNHS
Community
Advisory Council
your
voice
CONTENTS
3
4
Risks and Complications
4
Risk Prevention And Reduction 5
Pain Management
8
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Elective or Non-elective
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Following your Caesarean
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Vaginal blood loss
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Emptying your bowel Eating and Drinking
Emotional Recovery
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Caring for your Baby
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Physical Recovery
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17
19
19
Feeding
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IN
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After the birth and in hospital
Going Home
Visiting Midwifery Service
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Caesarean surgery
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Driving21
Child Health Nurse visits
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Postnatal check-up by your GP
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Sexuality22
Planning another baby
Useful Contacts
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Community Support
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KEMH telephone numbers
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Tear out easy reference guide
27
Information about caesarean birth support person
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KEMH Parent Education department host a Planning a Positive Caesarean
Birth Class, for dates and times please call (08) 9340 1368 between
8:00am - 9:00am or 3:00pm - 4:00pm weekdays (except Wednesdays).
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Important information - Caesarean admission
For Caesareans scheduled Tuesday to Friday, please call the Day
Surgery Unit (DSU) between 5.00pm and 6.00pm, the evening before
your admission, on (08) 9340 1459
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If you are having a support person at the birth please ask for the ‘Information
for a support person attending a Caesarean birth’ fact sheet, if you have not
already received one.
The incision is usually made just
above the pubic bone in the lower
part of the abdomen. A horizontal
cut is made and goes through skin,
fat. The muscle layers are pushed
aside, and the lining of the abdomen
(peritoneum) is opened to give
access to your womb (uterus) and
then a cut is made through the lower
part of the uterus to allow your baby
to be born. This is often referred
to as a Lower Uterine Segment
Caesarean Section (LUSCS). Less
frequently it may be necessary for
the incision to be made in the upper
segment of the uterus and this is called a Classical Caesarean Section.
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In some cases, a Caesarean birth plan (form no. MR290.01) is available
which may help personalise your experience. Please ask for a copy at your
Caesarean birth Pre-Admission Clinic.
A Caesarean is a major operation where your baby is born through a surgical
cut (incision) made in your abdomen.
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This booklet is meant as a guide only and is no substitute for your doctor or
midwife. Please ask those caring for you should you have any concerns or
questions about your Caesarean.
Caesarean surgery
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This booklet gives you and your family information that is commonly requested
by women who are preparing for a scheduled Caesarean birth or who have
already had a planned or unplanned Caesarean birth.
For Caesareans scheduled on a Monday please call between
5.00pm - 6.00pm on the Friday before.
If you become pregnant again following a Classical Caesarean Section, a
vaginal birth would not be recommended and another Caesarean section
would be performed.
Special instructions
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The lower segment is preferred because:
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DSU will:
• confirm your admission
• tell you what time to arrive for your Caesarean
• provide fasting instructions.
• it heals more strongly and bleeds less than the upper segment
• if you became pregnant again following a lower segment Caesarean
section, a vaginal birth may be possible.
• Do not shave, wax or use hair removal cream prior to your
Caesarean surgery.
• Shower with soap on the morning of your operation but do not use
talcum powder.
• Remove all jewellery and nail polish.
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‘Elective’ and ‘non-elective’ Caesarean
• Scalpel cut to baby.
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• after the start of labour
• less than 24 hours before the operation
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• when an elective Caesarean has been planned, but complications
such as labour or bleeding occur before the booked date meaning the
operation needed to be performed earlier.
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Risks and complications
Caesarean surgery is a common and relatively safe procedure but as with any
surgical procedure there are some risks and complications that can occur:
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• Excessive blood loss of three cups (750 mls) or more. Depending on the
degree of bleeding, some women may require a blood transfusion and /
or sometimes additional things such as extra stitches in the uterus
(B Lynch stitch) or a temporary balloon inside the uterus may be needed
to stop blood loss. This is uncommon. Very rarely, hysterectomy
(removing of the uterus) may be required to stop life threatening bleeding.
• Damage to organs surrounding the uterus, such as the bladder or bowel.
• Wound infection.
• Higher risk than vaginal birth of blood clots forming in the veins of the
pelvis and lower legs. If these clots move to the lungs (pulmonary
emboli) they can be fatal.
• Recovery is longer than for a vaginal birth.
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A non-elective, emergency or unscheduled Caesarean is when the decision for
the operation was made:
After returning home you may make an appointment to meet with the staff
involved in your care by phoning the clinical midwife consultant in Labour and
Birth Suite on (08) 9340 2222 - page 3317.
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• labour is artificially induced.
Your doctor and/or anaesthetist will have discussed other risks from the
anaesthetic and the Caesarean surgery with you however if you wish to
discuss these further ask your midwife to arrange for the doctor or anaesthetist
to visit you while in hospital.
Risk prevention and reduction
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• spontaneous rupture of the membranes
Your doctor and anaesthetist will take steps to make sure any risk to you or
your baby is minimised. There are also steps you can take to help you recover
faster.
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• the onset of labour
• Increase risk of baby having feeding problems
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An elective Caesarean is when the decision for the operation was made before:
• Baby having breathing problems requiring admission to the Neonatal
Intensive Care Unit.
Make sure you:
• Drink at least eight cups (two litres) of fluid per day.
• Get moving as soon as possible by getting out of bed the day of your
operation or, at the latest, the day after.
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The decision to have a Caesarean birth is made when there are signs that a
vaginal birth is too risky or when problems are experienced during labour.
Preventing excessive blood loss
• Expected blood loss at Caesarean section is less than 3 cups (750 mls).
• To reduce the risk of excessive blood loss the anaesthetist will give you
a medication called Syntocinon via your intravenous line immediately
after the birth of your baby. This will help your uterus to contract, thus
reducing the amount of bleeding.
• The surgeon will make sure the placenta, membranes and any clots are
removed from your uterus before repairing (closing) the incision. This
allows your uterus to contract and reduces the amount of bleeding.
• Possibility of complications with future pregnancies and/or births, e.g.
placenta growing into the scar tissue on the uterus, leading to severe
bleeding.
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• After having a catheter in the bladder some women may experience:
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-- discomfort when passing urine
-- incontinence (leaking) of urine
-- lack of sensation of a full bladder.
If you experience these problems talk to your midwife, doctor and
physiotherapist.
• You may notice increased swelling in your hands and feet at this time
which is normal. Continue to drink fluids, walk and go to the toilet
regularly and the swelling will go away. When resting, lie on your bed
and elevate your legs above the level of your heart.
• Pregnancy, childbirth and having had a catheter in your bladder increase
your risk of bladder infection. To decrease this risk the catheter is
removed as soon as possible. You should drink two to three litres of
fluid each day and empty your bladder regularly. Symptoms of bladder
infection are listed in the section: ‘When should I be concerned and seek
advice’ on page 27 of this booklet.
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• Antibiotics will be given during the operation to reduce the risk of wound
infection.
• A sterile area is maintained during the operation.
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• After the catheter is removed, empty your bladder every two to three
hours. Following the birth you will be losing body fluid that you gained
during your pregnancy. This creates a lot of urine in the first few days.
Keeping it empty will prevent over stretching of the bladder, help control
wound pain and reduce the amount of bleeding from your uterus.
• It is recommended not to shave, wax or use hair removal cream on your
pubic area prior to your caesarean.
• A sterile dressing will be placed over the wound before you leave the
operating theatre.
• You may be offered a preoperative chlorhexidine body wipe shortly
before your surgery.
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-- you have a normal urge to urinate
-- you pass 150 to 600mls of urine on more than two separate
occasions
-- your bladder empties completely and easily each time.
Preventing wound infection
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• The morning after your Caesarean (day two) your midwife will ensure
you are able to walk to the toilet before removing the catheter. Following
its removal the amount of urine will be measured. The bladder is
generally back to normal when:
• Hospital staff should always wash their hands before touching you or
your wound.
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• Before the operation a catheter (tube) is placed into the bladder to allow
urine to drain. This keeps the bladder empty and out of the way during
the operation. The catheter is inserted in theatre after the anaesthetic
has taken effect.
• Leaking urine may have been a problem during your pregnancy due
to the weight of your baby on your bladder and the hormones of
pregnancy, which tend to decrease your bladder control. If this problem
occurs or continues after your Caesarean, seek help from the KEMH
Physiotherapy Department or your local women’s health physiotherapist.
• Family or friends should not touch your wound or dressing.
• Visitors should wash their hands before and after visiting you.
Wound care
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Bladder protection
Always wash your hands before and after touching your wound.
Once your wound dressing has been removed:
• Gently wash with water when in the shower.
• Leave it to ‘air dry’ or gently dry around your wound with a clean towel.
• If your clothes are rubbing your wound, place a fresh sanitary pad
between the wound and your clothing. You may wish to purchase
underwear and clothing with a higher waistband to prevent rubbing.
• Staples/stitches will be removed as instructed by your doctor or after
about 96 hours. They may be removed at hospital or at home by the
visiting midwife.
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Preventing blood clots in lower leg veins
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• Avoid smoking and exposure to cigarette smoke during pregnancy
and after the birth of your baby. This will reduce the risk of blood clots
forming. Pregnancy and having a young child at home are good reasons
to give up smoking.
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• T.E.D.® stockings are given to you before the surgery and should be
worn until you leave hospital.
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• Keeping blood moving around your body reduces the risk of blood clots
forming. After the operation, work the muscles in your legs by moving
your legs and rotating your feet as demonstrated under ‘Circulation’ (page
15). You should start as soon as sensation and movement returns to your
legs. This activity promotes the return of blood to your upper body.
• If you are at risk of forming blood clots you may be prescribed bloodthinning medication (anticoagulants) by the doctor which are given daily
via an injection.
Pain management
You are likely to be offered a combination of medications to control your
pain. Combining medications gives the most effective pain relief. It reduces
the amount of each medication you need which may reduce your chance of
experiencing possible side effects such as dizziness, drowsiness, nausea,
vomiting, itch or constipation.
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Pain control starts before or during the operation and is achieved in three main
ways:
1. Epidural - pain relief medication (anaesthesia) containing opioids given
through a catheter in your back. A single dose of this medication into the
spinal area provides long-lasting, effective pain relief. In some cases,
medication can be ‘patient-controlled’ which will be explained to you.
You may safely use your epidural for pain relief for up to 48 hours, once
removed, strong pain relief medication may be taken by mouth. The
opioid medication used, can also be given via injection or mouth.
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-- shower daily and dress in fresh clothes
-- change bed sheets regularly and if they become soiled
-- cover your wound if it is oozing and report this to your midwife or
doctor immediately.
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• Keep clean and dry:
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• Avoid extremes of hot and cold temperature.
Your anaesthetist will discuss with you how your pain will be controlled. A ‘pain
team’ (including an anaesthetist and nurse) will visit you in your room to ensure
you are comfortable and are experiencing few or no side effects. If you have
any problems with your pain control your midwife can contact the anaesthetist.
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• Follow recommendations for exercise; warm muscles encourage blood
flow, cell growth and promote healing.
2. Paracetamol - medication that can be used while breastfeeding and can
be given by mouth or as a suppository.
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• Follow recommendations for eating and drinking (page 11).
There are several ways of getting pain control. Factors such as the type of
anaesthetic used, your individual circumstances, hospital practice and your
personal preference determine the type of pain medication you will receive.
3. Ibuprofen - anti-inflammatory pain-relief medications which will be
given frequently for a few days. They are very safe but not suitable for
everyone. This medication can be given as a tablet, a suppository or via
an injection
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To help healing:
The intravenous tube will be removed when:
• you are able to drink and eat
• the epidural is no longer needed.
If you have questions about the safety of medications and how they may affect
you and/or your baby please contact any of the following:
• midwife
• doctor
• anaesthetist
• pharmacist
• KEMH Pharmacy Help Line – Phone (08) 9340 2723
8.30am to 5.00pm, Monday to Friday
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Following Caesarean Surgery
Eating and drinking
Vaginal blood loss
Fluids
• You may drink fluids immediately following your operation.
Food
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• You may eat food immediately following your operation unless directed
otherwise by your midwife or doctor.
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• Well-balanced meals that include the five food groups are recommended.
-- nausea and vomiting
- breastfeeding, due to hormones released causing your uterus to contract
Emptying your bowel
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1. You should have a bowel movement on the second or third day after
your baby’s birth.
2. Visit the toilet as soon as you feel the urge. Don’t delay.
3. The best position for emptying your bowel is to lean forward and rest
your forearms on your knees, placing your feet on a foot stool can also
be helpful.
4. Prevent constipation by:
-- drinking two to three litres of water per day - this will make emptying
your bowel easier
-- eating fibre; whole grain cereals, fruits and vegetables
-- walk as advised in the ‘Physiotherapy and Exercise’ section (page 12).
If pain or illness prevents this activity you should consult your doctor.
5. If you experience constipation, talk to your midwife as soon as possible
about a management plan.
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Physical Recovery
It is important that you give your body time to recover and to heal. Healing
continues to occur internally for several weeks so avoid strenuous activity for six
to eight weeks after your Caesarean.
Rest
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3. Sanitary pads should be changed at least every four hours to reduce the
chance of infection.
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-- rare complications of surgery involving your bowel, your surgeon will
have already discussed this with you.
- you get home and increase your activity.
This should settle again within half an hour. Small clots (no bigger than a 50 cent
piece) can also be passed at this time.
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• Possible reasons that you may not tolerate food are:
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- you get out of bed, due to gravity
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2. Your loss may increase slightly when:
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1. The loss over the next five days will decrease in amount and change
colour. It will change from bright red to watery pink to a dark red/brown
colour by day five (similar to a period).
• Adults are advised to drink at least eight cups (two litres) of fluid each day.
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Immediately after the birth, your vaginal blood loss will be bright red in colour and
the amount should not fill a regular sized sanitary pad in less than four hours.
To get as much rest as possible try these suggestions while in hospital and
when you are at home:
• Use the amount of pain relief that you require as directed by your doctor.
• Use the rest period the hospital has arranged between 1pm and 3pm.
• When in hospital use your ‘Do Not Disturb’ sign by placing it on your
closed door when you are resting.
• Take the phone off the hook and turn your mobile phone to silent.
• Put the back of the bed flat when resting if comfortable.
• Keep visitors to a minimum for the first 24 to 48 hours and ask they keep
their visits short (15 to 20 minutes).
• Keep your baby’s cot close to your bed so you can easily attend to your
baby.
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In hospital:
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Physical recovery goals
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Remember to listen to your body. If you feel tired or your wound aches, then
your body is telling you to rest. Gradually increase your activity as your healing
and recovery allows.
Day 1: Getting out of bed the day of your baby’s birth.
Day 2: Walking to the shower and around your room throughout the day.
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Day 3: Short walks around your ward, in preparation for going home.
• Each day, increase the number of times, and the length of
time you go for walks around your room and ward.
• Do the ‘Gentle exercises for tummy and back’ on the following
page. These exercises are important to help your tummy muscles
function and to ease or prevent back pain.
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• Only attempt light housework at first (dusting, light sweeping, and
washing dishes). After about six weeks you can gradually progress to
vacuuming a small room, etc.
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It is important for your recovery that you are up and walking as soon as
possible, your midwife and health care team will help you to achieve this.
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Physiotherapy and exercise
• You can start the pelvic floor and tummy exercises in the ‘Physiotherapy
After Childbirth’ brochure (provided by the Physiotherapy Department)
as soon as you feel comfortable (usually day three). If they cause you
pain, stop and try again a day or two later.
• Avoid lifting anything heavier than your baby for the first six weeks.
For example you should not be lifting loads of wet washing, toddlers,
shopping bags, full baby baths or baby capsules. If you need to hold
your breath the load is too heavy. You are able to lift very light loads
such as your baby, a few garments in a washing basket, a light shopping
bag etc. After six to eight weeks you may be ready to start lifting slightly
heavier loads (but with caution).
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• Accept offers of help from your family and friends.
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• Perhaps for the first one or two days at home your other children can
stay with family or carers.
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• Arrange care for your other children so you can rest.
• When you feel able, take a daily walk pushing your baby in the pram.
Start by walking for 10 to 15 minutes on fairly flat ground. Gradually
increase your pace of walking and the length of time you walk for, as
you feel stronger.
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• Nap during the day when your baby is sleeping.
At home:
To protect your back and limit the strain on your scar, the correct lifting
technique is essential:
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• Ask your partner or family to look after your baby if you find it difficult to
rest with your baby in the room.
• BEND your knees
• BRACE your tummy muscles and pelvic floor.
• BRING the object close to your body.
• BREATHE out as you lift.
Good posture will reduce the strain on your back:
• Stand Tall
• Walk Tall
• Sit Tall
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Deep breathing
Circulation
• Deep breathing helps
reduce the side effects of the
anaesthetic.
• Move feet up and down briskly at the ankles at least ten times per hour,
even if sitting out of bed.
Getting out of bed after your operation
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Huffing
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• Coughing places more stress on your
tummy and pelvic floor muscles so it is
better to huff to clear phlegm from your
chest.
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• Take a medium sized breath in and then
force the air out through a rounded mouth
as if you are fogging up a mirror. Aim for
a long huff out.
• If you need to cough or sneeze hold your
tummy as pictured. Remember to tighten
your pelvic floor muscles at the same
time.
Walking
• Sit on the edge of the bed with your feet flat on the floor, lean forward
and stand up.
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• Aim for five deep breaths every hour
• As you push up with your hands to a
sitting position, swing your legs down
over the side of the bed.
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• Breathe out gently, then take
a slow deep breath getting in
as much air as possible. Relax and gently breathe out.
This may also be done in a chair.
• Bend your knees up and roll onto
your side. Keep your knees together
and pulled up towards your chest.
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• Sit up in bed, knees bent,
feet on the bed. Place one
hand on your tummy above
your navel.
Coughing, showing the position of
Walking is the best exercise. You may need
your hands while sitting in a chair.
someone with you if you feel unsteady. Start with
frequent short walks. Progress to a full lap of the ward.
Do this several times a day, resting between each lap.
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Gentle exercises for the abdomen and back
Physiotherapy Department
These gentle exercises help to:
For information or assistance phone (08) 9340 2790 (extension 2790 within the
hospital), Monday to Friday 8.30am to 4.30pm.
• tone the tummy (abdominal) muscles,
• relieve backache,
Emotional Recovery
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Knee rolling
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Lying with knees bent and together, pull your
tummy in. With knees together roll first to
one side and then to the other – a little way
to each side at first and gradually increasing.
If you feel sharp pain whilst doing these
exercises, stop exercising and seek
guidance from your midwife, doctor or
physiotherapist.
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Having an unplanned Caesarean can sometimes be distressing. Occasionally
women may experience a sense of loss of control, trauma, anxious feelings or
disappointment relating to the birth.
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Lie with your knees bent, hands on your hipbones. Tilt your hipbones towards
your face and flatten the lower back. Hold for two to three seconds, release
slowly, allowing the hollow in your lower back to reform. Repeat rhythmically
10-15 times, twice a day.
There are many reasons why birth by Caesarean happens. For some women
the decision may have been made many weeks before the birth. Others may
have experienced a labour that ended up as a Caesarean. It is often very
valuable to talk about your expectations, thoughts and feelings with supportive
family and friends and with the midwives and doctors who shared your birth
experience.
On the positive side, these feelings are often intermingled with a sense of relief
that the procedure is over and that both mother and baby are safe. Difficult
emotional reactions will hopefully settle within a short period of time.
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Pelvic rocking
Midwives and doctors are happy to arrange a convenient time to talk through
memories and feelings of your labour and birth experience. While still in hospital
you may arrange an appointment with these carers by asking your midwife, or
after returning home, by phoning the clinical midwife consultant in Labour and
Birth Suite (08) 9340 2222 and asking for page 3317 or the midwives from the
Next Birth After Caesarean (NBAC) clinic on (08) 9340 1626.
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• assist passing of wind.
If you wish to speak to someone independent from your experiences you can
ask for a referral to the Department of Psychological Medicine, a service with
specialised staff who offer a confidential consultation to help you deal with any
persistent, emotional reactions either while in hospital or after you have gone
home. You may self refer for up to six months after you had your baby and for
up to 12 months if you baby was in the Special Care Nursery by phoning
(08) 9340 1521. The patient advocate is also available on (08) 9340 1559.
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There are some simple things that you can do to improve your emotional
wellbeing:
After the birth and in hospital
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• Plan at least one outing or activity each day such as hobbies and
exercise, or restful activities like reading and watching television.
• Contact friends regularly.
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• Join a mothers group, your child health nurse may have information and
contact details.
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• When you’re feeling housebound, walk with your baby to the local park
or shops - your new baby will encourage others to talk to you.
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• Write in a journal or diary.
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Acknowledge your feelings. It is possible to feel happiness at having a healthy
baby and at the same time have mixed feelings about how the birth went.
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Following birth, your baby may need:
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• Ask for help when needed.
• Warming through skin-to-skin contact with you or under a heater.
• A beanie - you may wish to bring a washed one for your baby to wear
after the birth.
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• Accept offers of help, such as washing and cleaning.
• Observation, and perhaps treatment, in the Special Care Nursery. If your
baby does need this care you will be told immediately and contact with
your baby will be assisted, depending on you and your baby’s health.
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At home
Your baby will room-in with you 24 hours a day. The midwife will assist you to
care for your baby in your room. As you become more confident and mobile
your midwife will encourage you to become more independent in caring for
your baby.
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• Telephone supportive friends and family.
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• Dress in your own clothes, do your hair and make-up.
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While in hospital
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Caring for your baby
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Feeding your baby
Going home
Breastfeeding
You can expect to go home three days following a Caesarean birth. During
busy times, when bed availability is reduced you and your baby may be
required to transfer to another hospital, closer to your home.
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To achieve this your midwife and family can assist you to position yourself with
your baby comfortably in bed or in a chair. Your midwife will encourage you to
have lots of contact with your baby.
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For further information please refer to the booklet ‘Breastfeeding and Breast
Care’.
Formula feeding
When bottle feeding your baby it is important that both you and your baby are
comfortable and warm. The need for closeness and cuddling is important.
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For further information please refer to the pamphlet ‘Formula feeding - a guide
for parents’.
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• take pain medication regularly
• observe your wound as it heals and report any problems to your doctor
• have an afternoon rest
• exercise as previously described in this booklet
• ask family and friends to help with house cleaning, preparing food and
care of other children.
Visiting Midwifery Service (VMS)
This service provides assessment by a midwife in your own home. If you are
expecting a visit from VMS, please remain home until seen.
Your care at home will be referred to the VMS if:
Support services for feeding your baby
• you left the hospital before day five
Contact details can be found towards the back of this booklet.
• you or your baby require daily assessment by a midwife.
• Breastfeeding Centre of WA located at KEMH
• Australian Breastfeeding Association
• Child Health Nurse – local Child Health Clinic
• Ngala
Your baby’s purple Personal Health Record book and your telephone directory
are also good sources for community assistance that is available in your area.
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You should continue to:
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6. Correct attachment when feeding.
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5. Allow the baby to determine the frequency and length of each breastfeed.
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4. Unrestricted breastfeeding – loose comfortable clothing.
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3. Comfortable positioning of yourself and your baby.
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2. Adequate pain control.
A doctor will see you and your baby before you leave the hospital to discuss
contraception and pain relief and provide you with medication and/or
information, as required. Once home, effective pain relief and a supportive
family remain an important part of your recovery.
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1. Skin-to-skin contact between you and your baby as soon as possible
after birth and as often as possible.
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Successful breastfeeding is encouraged by:
Driving a vehicle
Austroads guidelines state that women who have had a birth by Caesarean
‘should not drive for four weeks or until cleared by a medical practitioner.
Ask your doctor at the hospital or your GP if you are able to drive safely.
You should not drive a vehicle if you are in pain or are using medication that
has the warning, ‘Care should be taken when driving or operating machinery’.
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You will find the phone number and address of your local Child Health Nurse in
your baby’s Personal Health Record. During the first week at home with your
baby you should call the phone number and arrange an appointment with the
Child Health Nurse. If you wish to choose a different Child Health Nurse your
phone book has listings under ‘Child Health Services’.
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Postnatal check-up by General Practitioner
Your nominated GP will receive a summary of your stay in hospital and birth
details.
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Arrange an appointment for yourself and your baby six weeks after the birth.
See your GP sooner if there are any problems that you need to discuss or
have treated.
Sexuality
• The best gauge of when you are ready to resume sex is how you are
feeling.
• Careful positioning may be helpful to prevent pain in the wound area.
• A common side effect of surgery is a numb sensation around the wound
that can last a year or more. Touching this area can be uncomfortable
for some women.
F
O
• whether the next pregnancy has complications.
For most women it is best not to plan another pregnancy for at least 12 months
after a Caesarean.
O
O
Child Health Nurse
• the reason for this Caesarean
PR
O
F
Most vehicle insurance companies insure drivers after they have had an
operation if they follow the instructions of their doctor. If you are unsure of your
insurance company’s policies please phone them and check your accident
coverage.
For information about your birthing options after having a Caesarean, please
contact the KEMH Next Birth After Caesarean (NBAC) clinic on (08) 9340 1626
or visit http://www.kemh.health.wa.gov.au/services/NBAC/index.htm
S
• turning to look over your shoulder to reverse.
When planning a future pregnancy you should discuss your birth options and
possible risks of another pregnancy with your obstetrician, doctor or midwife.
It may be possible to achieve a vaginal birth with your next pregnancy
depending on:
Your doctor will discuss contraception with you, providing you with medication
and/or information, if you wish, before you leave the hospital. Remember when
you are sexually active it is always possible to become pregnant regardless of:
R
• turning the steering wheel
Planning another baby
IN
TE
• pushing the pedals (could you brake suddenly?)
• time passed since you gave birth
• evidence of menstrual period
• breastfeeding.
PR
Generally you are safe to drive when you feel comfortable:
Further information
Maternal and infant health publications and information are available from:
• Antenatal clinics
• Hospital wards
• Parent Education Department
• Women and Newborn Health Library, a consumer health library located
in the Main Corridor of KEMH.
Phone: (08) 9340 1100
Fax: (08) 9340 1124
• Breastfeeding can reduce vaginal secretions, a water-based lubricant
gel may be useful.
22
23
KEMH phone numbers
Useful Contacts
Community support
Antenatal Clinic
(08) 9340 1536
Ngala Family Resource Centre
(08) 9368 9368
(08) 6279 1200
or 1800 654 432
The Bump
(08) 9498 6033
Post Natal Depression Support Association
(PNDSA)
(08) 9340 1622
F
O
Diagnostic Imaging Department
(08) 9340 2163
(08) 9340 2700
Emergency Centre KEMH (24 hours)
(08) 9340 1433
Genetics Department
(08) 9340 1525
R
Under ‘L’ in the Yellow Pages
1800 33 00 66
PR
Diabetes Educator
KEMH Switchboard (24 hours)
National Continence Help line
Parent Help Centre
24
1800 022 222
(08) 9340 2222
(Pager 3425)
IN
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Multiple Birth Association of WA (Inc)
(08) 9227 6177
Women and Newborn Drug and Alcohol Service
(08) 9340 2222
Labour and Birth Suite (24 hours)
(08) 9340 2199
Next Birth After Caesarean Clinic
(08) 9340 1626
Parent Education Department
(08) 9340 1368
Patient Advocate
(08) 9340 1559
Pharmacy Help Line
(08) 9340 2723
Physiotherapy Department
(08) 9340 2790
Psychological Medicine
(08) 9340 1521
Social Work Department
(08) 9340 2777
Visiting Midwifery Service
(08) 9340 1530
Women and Newborn Health Library
(08) 9340 1100
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Lactation Consultants (Private)
(08) 9443 4323
(08) 9340 1844
O
O
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S
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Health Direct Emergency
(24-hour medical advice line)
O
Ethnic Child Care Resource Unit Inc
Family Planning of Western Australia
www.birthrites.org
F
Birthrites: Healing After Caesarean Inc
Breastfeeding Centre of WA
PR
1800 686 268
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Australian Breastfeeding Association
(Fax) (08) 9340 1031
25
Other useful resources:
When should I be concerned or seek advice?
Contact your midwife or doctor if:
Page 1
Government of Western Australia
Physiotherapy
after Childbirth
Six ways to sleep your baby safely and reduce the
risk of sudden unexpected death in infancy (SUDI):
* Medical advice may be needed for babies
with a severe disability
This brochure is endorsed by the Womens and Newborns
Health Network of Western Australia (2008).
** While breastfeeding is best, it may not be
possible for every mother
This document can be made available
in alternative formats on request for
a person with a disability.
d Newborn Health Service
wa.gov.au
wa.gov.au
498 Rev 3, Revised May 2014
Compiled by: Women and Newborn Health Service,
Womens and Newborns Health Network and
Child and Adolescent Health Service
Web: www.wnhs.health.wa.gov.au
© July 2008 WNHS 0489 Rev 3 Reviewed October 2014
nformation contained herein is provided in
. However the accuracy of any statements
t is the responsibility of readers to make their
acy, currency and appropriateness of any
d. Liability for any act or omission occurring in
for any loss, damage or injury occurring as a
omission is expressly disclaimed.
Disclaimer: The advice and information contained herein is provided in
good faith as a public service. However the accuracy of any statements
made is not guaranteed and it is the responsibility of readers to make their
own enquiries as to the accuracy, currency and appropriateness of any
information or advice provided. Liability for any act or omission occurring in
reliance on this document or for any loss, damage or injury occurring as a
consequence of such act or omission
is expressly disclaimed.
WNHS
To sleep your baby
safely follow these
recommendations
wherever your baby
sleeps, including at
the home of friends or
relatives.
your
voice
Photos for illustration purposes only.
Breastfeeding and
Breast Care
WNHS 0159
Safe Infant
Sleeping
WNHS 0489
Physiotherapy
after Childbirth
WNHS 0556
Government of Western Australia
Government of Western Australia
Department of Health
Women and Newborn Health Service
Treatment
After an initial assessment, the clinician and patient
will discuss whether presenting problems may
be best managed by the Department’s services
or whether the patient may be better served by
a referral to community services. Patients may
choose to be treated closer to home and request a
referral to relevant community services.
Department of Health
Women and Newborn Health Service
We use this feedback to improve services and
for program development and planning. Although
participation is encouraged, giving feedback is
completely voluntary, can be anonymous and
providing feedback will not affect your treatment and
care.
Staff participate in training to promote cultural
awareness and sensitivity of our services. Auslan
or Interpreter Services can be arranged for patients
with hearing difficulties or those from a non-English
speaking background.
Six Week Check
Your mental health information is stored in your
medical records and a confidential database.
N EWB ORN HEALTH SERVICE
dward Memorial Hospital
Psychological
Medicine may be asked by the
ot Road Subiaco
WA 6008
hospital
to help with patients who could be at risk of
phone: (08)
9340 2222
harm to themselves or others.
Consumer
s document
can be made Service
available Evaluation
alternative formats on request for
Patients are invited to be actively involved in all
erson with a disability.
aspects of their care from assessment through to
treatment, referral, follow-up and discharge planning.
Patients
are encouraged to provide feedback about
and Newborn
Health Service
h.wa.gov.auour services by using the suggestion boxes around
533 Rev 4 the
Revised
September
2014
hospital
or forms
available in the waiting room,
or by asking to speak directly to staff or the Head or
s vested in the State of Western Australia
Associate
Head
of Department.
Apart from any
fair dealing for
the purposes
criticism or review, as permitted under the
Act 1968, no part may be reproduced or
whatsoever without written permission of the
Department of
Psychological
Medicine
Please contact us for more information.
Department of Psychological Medicine
1st Floor, Agnes Walsh House
King Edward Memorial Hospital
Hours: 9.00am – 4.30pm Monday – Friday
Telephone: (08) 9340 1521
Fax: (08) 9340 1111
This document can be made available
in alternative formats on request for
a person with a disability.
Produced by Department of Psychological Medicine KEMH
Web: www.wnhs.health.wa.gov.au
© March 2008 WNHS 0505 rev 3 Revised October 2014
Disclaimer: The advice and information contained herein is provided in
good faith as a public service. However the accuracy of any statements
made is not guaranteed and it is the responsibility of readers to make their
own enquiries as to the accuracy, currency and appropriateness of any
information or advice provided. Liability for any act or omission occurring in
reliance on this document or for any loss, damage or injury occurring as a
consequence of such act or omission is expressly disclaimed.
Copyright to this material is vested in the State of Western Australia unless
otherwise indicated. Apart from any fair dealing for the purposes of private
study, research, criticism or review, as permitted under the provisions of the
Copyright Act 1968, no part may be reproduced or re-used for any purposes
whatsoever without written permission of the State of Western Australia.
Photos for illustration purposes only.
Six week check
WNHS 0533
Government of Western Australia
Department of Health
Women and Newborn Health Service
The next nine months...
Information, advice and support after the birth of your baby at KEMH
Information for Patients
PR
Patients can expect to be informed of why they
were referred and have the assessment process,
outcomes and recommendations for treatment
options clearly explained to them and their support
person. They have the right to decline a referral
for an assessment and to decide on the best
treatment recommendations or follow-up plans
for them. Patients have the right to seek a second
opinion regarding assessments and treatment
recommendations.
IN
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Birth after
Caesarean
WNHS0498
PR
es only.

These recommendations have been
adapted from SIDS and Kids WA
www.sidsandkidswa.org/keepingbaby-safe/safe-sleeping-tips.aspx
Copyright to this material is vested
in the State of Western Australia unless
Community
otherwise indicated. Apart fromAdvisory
any fair dealing
Council for the purposes of private
study, research, criticism or review, as permitted under the provisions of the
Copyright Act 1968, no part may be reproduced or re-used for any purposes
whatsoever without written permission of the State of Western Australia.
ested in the State of Western Australia unless
m any fair dealing for the purposes of private
eview, as permitted under the provisions of the
may be reproduced or re-used for any purposes
ermission of the State of Western Australia.

O
document can be made available
ernative formats on request for
rson with a disability.
Department of
Psychological
Medicine
WNHS 0505
Open House Postnatal Program
Join in a series of informal discussions led by
Parent Educators and guest speakers every
second and fourth Tuesday of the month exploring
a range of topics relating to newborns and
women’s health.
Share your experiences, get advice from the
experts and socialise with other new parents.
Program over page.
Who: New parents and their babies up to nine months old.
When: 1.30pm every SECOND and FOURTH Tuesday of the month.
Where: Agnes Walsh House (next door to KEMH, Bagot Road).
Baby Massage Course
Time used for massage can benefit both you and
your baby, come and learn the correct techniques
from a trained infant massage instructor.
Who: Parents and their babies between six and
twelve weeks (3 months).
When: Once a week for four weeks (1-1.5 hours
per session). Bookings essential.
Where: KEMH Parent Education Department,
1st Floor, A Block.
* Gold coin donation appreciated for this course to cover costs of massage oils and information sheets.
For more information about the Open House Program or to book a place in the
Baby Massage Course call (08) 9340 1368 between 8.00am and 9.00am or
3.00pm and 4.00pm weekdays (except Wednesdays).
The next nine months...
WNHS 0107
26
O
Road Subiaco WA 6008
hone: (08) 9340 2222
F
ward Memorial Hospital
Sleep baby on back*
Keep baby’s head and face uncovered
Keep baby smoke free before and after birth
Safe sleeping environment night and day
Sleep baby in a safe cot in parent’s room
Breastfeed baby**
WNHS
Community
Advisory Council
your
voice
O
374 Bagot Road Subiaco WA 6008
Telephone: (08) 9340 2222
EWB OR N HEALT H SERVICE
Phone Number: (08) 9340 1521
Contact the KEMH Department of Psychological Medicine if:
• You experience depressive, anxiety symptoms or other emotional difficulties
Phone Number: (08) 9340 1844
Contact the Breastfeeding Centre of WA or your lactation consultant if
you have:
• Breastfeeding problems of any kind
Phone Number: (08) 9340 2170
PR
King Edward Memorial Hospital
This page may be removed for easy reference
1.
2.
3.
4.
5.
6.
W O ME N A ND NE W B O R N H EA LT H SERV IC E
O
he women who so generously
otos for use in this publication.
PR
Information for Parents, Carers
and Families
picture tells a story.
you have a fever, shivering or sweating
you have stinging or burning when you pass urine
you notice increasing redness, inflammation and tenderness in your wound
pus, blood or fluid leaks from your wound
your vaginal loss returns to a bright red colour, unexpectedly increases in
amount, or smells offensive
• you experience a hard, red and painful lump in a breast that is not relieved
after following advice given in the booklet ‘Breastfeeding and Breast Care’
• tiredness is not improving or is getting worse
• you are worried.
F
•
•
•
•
•
Department of Health
Women and Newborn Health Service
Safe Infant
Sleeping
Breastfeeding and
Breast Care
Birth After
Caesarean
Government of Western Australia
S
Department of Health
Women and Newborn Health Service
R
Department of Health
Women and Newborn Health Service
Government of Western Australia
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Page 8
Government of Western Australia
Department of Health
Women and Newborn Health Service
Contact your physiotherapist if one or more of the following problems
happen or continue after your baby is born:
•
•
•
•
•
•
•
•
•
•
•
back or neck pain
Caesarean scar pain
weak abdominal muscles
painful tailbone
haemorrhoids or pain when using bowels
blocked milk ducts/mastitis
loss of bladder/bowel sensation or control
urgency to pass urine or use bowels
passing urine frequently
difficulty keeping tampon in place
pain during sexual intercourse.
27
28
Pain Relief
Colour: S
Suppositories and paracetamol
R
pink to light brown
Amount: decreasing amount each day
Shower, walks
around room
PR
O
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Around ward area 2 - 3 times a day
Increase number and length of walks each day
S
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PR
1. Use the rest period from 1pm to 3pm provided by the hospital.
2. Use your ‘Do Not Disturb’ sign.
3. Take the phone off the hook.
4. Close your door.
5. Nap when your baby is sleeping.
6. Restrict number of visitors and ask them not to stay too long.
7. Talk to you medical team or supportive family and friends about your birth
if you.
found it distressing or traumatic.
Physical recovery is important to your emotional wellbeing
Colour: Nil
Amount: Nil
6 Weeks
Daily walk
F
• reduce safety and health risks to the staff and support person
• reduce risk of infection
• limited space.
PR
F
O
O
1. Arrange child care for other children.
2. Use help from family and visitors.
3. Nap when your baby is sleeping.
4. Take a break - walk or just relax.
5. Contact Psychological Medicine if you feel.
distressed, anxious or depressed.
Attend postnatal
exercise class in
the Physiotherapy
Department
Paracetamol as required.
Other medications may be
required - discuss with your doctor
and midwife
Start Pelvic floor and abdominal exercises in the
Start ‘Gentle Exercise for Abdominal Muscles and Lower
“Physiotherapy before and after childbirth” pamphlet
Back’ on page 16.
provided by the Physiotherapy Department
Sit out of bed
GOALS FOR RECOVERY
Rest
Exercise
Stitches or staples
removed in hospital
or your home after 96
completed hours
Day 5
Effective pain relief enables a quicker recovery and improves your ability to care for yourself and your family
Patient Controlled Epidural
Analgesia (PCEA), suppositories,
paracetamol, anti-inflammatories
Daily visit by Anaesthetic Pain Team
Vaginal Loss
Walk
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Leave wound
uncovered but protect from
clothing with sanitary pad
Day 4
Report concerns about healing to your midwife or doctor, see back of this page
Amount: half fills regular pad in 2-4 hours
Colour: bright red blood
Wound
PR
Eat well balanced meals using the five food groups
Wound is
covered for
24 hours
Drink at least 8 cups (2 litres) fluid each day
Day 3
Eat
Day 2
Drink
Day 1
(Birth Day)
Information for a support person attending a
caesarean birth
A support person can be present at a caesarean birth to provide moral
support and encouragement for the woman giving birth.
The woman’s caesarean section is done while she is awake under epidural/
spinal anaesthesia. If the woman becomes unwell, the surgery will be
performed under a general anaesthetic (i.e. she will be asleep) and you will
be asked to leave the theatre.
Only one support person is able to come into the theatre due to following:
Appropriate clean and covered footwear must be worn at all times (NO
THONGS).
You will be supplied with:
• Disposable theatre clothing to put on over your own clothes while you
are in the Theatre Department.
• A disposable hat to wear for the time you are in the Theatre
Department.
• A name tag (white sticker with your name on) so we can identify you
as the support person.
Please note:
Children are not permitted in the theatre and should not be left unsupervised
in the waiting room. Childcare must be arranged prior to arriving at theatre.
While the woman you are supporting is having her epidural/spinal
anaesthetic, you will be asked to wait in the lounge area near the lifts on
Level 2 outside theatre. A comment book has been provided for you to
record your thoughts and feelings.
29
You can bring a camera (no smart phones or devices) with you to take
photos of the baby and mother. Only still photography is permitted in theatre,
no video recording of any type is allowed. Please refrain from taking photos
of the staff or the operation.
Notes
................................................................................................................................................................................
................................................................................................................................................................................
Please note - mobile phones are NOT permitted in the theatre.
PR
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................................................................................................................................................................................
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After the caesarean section is finished you will be asked to wait on the ward
until the woman returns. Support people are not permitted in the recovery
room unless approval has been given by theatre staff. Please remove your
disposable theatre clothing and place in the rubbish bin outside of recovery
before leaving the theatre suite. If the baby is being transferred directly to the
ward or special care nursery by the midwife, you can accompany them.
................................................................................................................................................................................
................................................................................................................................................................................
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F
Please remain seated whilst in the operating theatre for your safety unless
requested otherwise. Always remain seated whilst holding the baby.
................................................................................................................................................................................
We hope that you have an enjoyable theatre experience.
................................................................................................................................................................................
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S
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S
If you are unsure of anything while in theatre please ask a staff member.
................................................................................................................................................................................
................................................................................................................................................................................
................................................................................................................................................................................
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Notes
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33
This document can be made available
in alternative formats on request for
a person with a disability.
Compiled by: Physiotherapy Department
Produced by: Women and Newborn Health Service
Website: www.wnhs.health.wa.gov.au
© August 2005 WNHS 0011 Rev 7
Revised May 2015
W O M E N A N D N EW B OR N H E A LTH S E RV IC E
King Edward Memorial Hospital
374 Bagot Road Subiaco WA 6008
Telephone: (08) 9340 2222
Disclaimer: The advice and information contained herein is provided in good faith as a public service.
However the accuracy of any statements made is not guaranteed and it is the responsibility of readers to
make their own enquiries as to the accuracy, currency and appropriateness of any information or advice
provided. Liability for any act or omission occurring in reliance on this document or for any loss, damage
or injury occurring as a consequence of such act or omission is expressly disclaimed.
Copyright to this material is vested in the State of Western Australia unless otherwise indicated. Apart
from any fair dealing for the purposes of private study, research, criticism or review, as permitted under
the provisions of the Copyright Act 1968, no part may be reproduced or re-used for any purposes
whatsoever without written permission of the State of Western Australia.
Photos for illustration purposes only.